Effect of Physician Volume on the Relationship Between Hospital Volume and Mortality During Primary Angioplasty

V. S. Srinivas, Susan M. Hailpern, Elana Koss, E. Scott Monrad, Michael H. Alderman

Research output: Contribution to journalArticle

96 Citations (Scopus)

Abstract

Objectives: We sought to examine the combined effect of hospital and physician volume of primary percutaneous coronary intervention (PCI) on in-hospital mortality. Background: An inverse relationship between volume and outcome has been observed for both hospitals and physicians after primary PCI for acute myocardial infarction. Methods: Using the New York State PCI registry, we examined yearly hospital volume, physician volume, and risk-adjusted mortality in 7,321 patients undergoing primary PCI for acute myocardial infarction. Risk-adjusted mortality rates for high-volume hospitals (>50 cases/year) and high-volume physicians (>10 cases/year) were compared with their respective low-volume counterparts. Results: Primary PCI by high-volume hospitals (odds ratio [OR]: 0.58; 95% confidence interval [CI]: 0.38 to 0.88) and high-volume physicians (OR: 0.66; 95% CI: 0.48 to 0.92) was associated with lower odds of mortality. Furthermore, there was a significant interaction between hospital and physician volume on adjusted mortality (p = 0.02). Although unadjusted mortality was lower when primary PCI was performed by high-volume physicians in high-volume hospitals compared with low-volume physicians in low-volume hospitals (3.2% vs. 6.7%, p = 0.03), the risk-adjusted mortality rate was not statistically significant (3.8% vs. 8.4%, p = 0.09). In low-volume hospitals, the average risk-adjusted mortality rate for low-volume physicians was 8.4% versus 4.8% for high-volume physicians (OR: 1.44; 95% CI: 0.68 to 3.03). However, in high-volume hospitals, the risk-adjusted mortality rate for high-volume physicians was 3.8% versus 6.5% for low-volume physicians (OR: 0.58; 95% CI: 0.39 to 0.86). Conclusions: During primary PCI, physician experience significantly modifies the hospital volume-outcome relationship. Therefore, policymakers need to consider physician experience when developing strategies to improve access to primary PCI.

Original languageEnglish (US)
Pages (from-to)574-579
Number of pages6
JournalJournal of the American College of Cardiology
Volume53
Issue number7
DOIs
StatePublished - Feb 17 2009

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Hospital Mortality
Angioplasty
Physicians
Percutaneous Coronary Intervention
High-Volume Hospitals
Mortality
Low-Volume Hospitals
Odds Ratio
Confidence Intervals
Myocardial Infarction
Registries

Keywords

  • coronary disease
  • hospital volume
  • outcome
  • physician volume
  • primary angioplasty

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Effect of Physician Volume on the Relationship Between Hospital Volume and Mortality During Primary Angioplasty. / Srinivas, V. S.; Hailpern, Susan M.; Koss, Elana; Monrad, E. Scott; Alderman, Michael H.

In: Journal of the American College of Cardiology, Vol. 53, No. 7, 17.02.2009, p. 574-579.

Research output: Contribution to journalArticle

Srinivas, V. S. ; Hailpern, Susan M. ; Koss, Elana ; Monrad, E. Scott ; Alderman, Michael H. / Effect of Physician Volume on the Relationship Between Hospital Volume and Mortality During Primary Angioplasty. In: Journal of the American College of Cardiology. 2009 ; Vol. 53, No. 7. pp. 574-579.
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AU - Alderman, Michael H.

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AB - Objectives: We sought to examine the combined effect of hospital and physician volume of primary percutaneous coronary intervention (PCI) on in-hospital mortality. Background: An inverse relationship between volume and outcome has been observed for both hospitals and physicians after primary PCI for acute myocardial infarction. Methods: Using the New York State PCI registry, we examined yearly hospital volume, physician volume, and risk-adjusted mortality in 7,321 patients undergoing primary PCI for acute myocardial infarction. Risk-adjusted mortality rates for high-volume hospitals (>50 cases/year) and high-volume physicians (>10 cases/year) were compared with their respective low-volume counterparts. Results: Primary PCI by high-volume hospitals (odds ratio [OR]: 0.58; 95% confidence interval [CI]: 0.38 to 0.88) and high-volume physicians (OR: 0.66; 95% CI: 0.48 to 0.92) was associated with lower odds of mortality. Furthermore, there was a significant interaction between hospital and physician volume on adjusted mortality (p = 0.02). Although unadjusted mortality was lower when primary PCI was performed by high-volume physicians in high-volume hospitals compared with low-volume physicians in low-volume hospitals (3.2% vs. 6.7%, p = 0.03), the risk-adjusted mortality rate was not statistically significant (3.8% vs. 8.4%, p = 0.09). In low-volume hospitals, the average risk-adjusted mortality rate for low-volume physicians was 8.4% versus 4.8% for high-volume physicians (OR: 1.44; 95% CI: 0.68 to 3.03). However, in high-volume hospitals, the risk-adjusted mortality rate for high-volume physicians was 3.8% versus 6.5% for low-volume physicians (OR: 0.58; 95% CI: 0.39 to 0.86). Conclusions: During primary PCI, physician experience significantly modifies the hospital volume-outcome relationship. Therefore, policymakers need to consider physician experience when developing strategies to improve access to primary PCI.

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